Processes of care desired by elderly patients with multimorbidities
Processes of care desired by elderly patients with multimorbidities
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DOI：
10.1093/fampra/cmn040
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发表时间：
2008-08-01
期刊：
影响因子：
2.2
通讯作者：
Main, Deborah S.
中科院分区：
文献类型：
--
作者：
Bayliss, Elizabeth A.;Edwards, Allison E.;Main, Deborah S.
背景。大多数推荐的慢性病护理都是基于对单一疾病的研究。关于多重疾病患者的“最佳”护理程序的信息有限。我们的目的是探讨老年患者所期望的护理过程，这些老年患者患有多种疾病，可能对患者和提供者提出相互竞争的需求。对26名65-84岁的社区HMO成员（50%为男性）进行一对一访谈，进行定性调查，这些成员至少患有糖尿病、抑郁症和骨关节炎。参与者是从分层随机抽样中选出的，他们有4-16种慢性疾病。参与者期望的护理过程包括：需要方便地访问提供者（电话，互联网或亲自），个性化护理计划的明确沟通，来自单一护理协调员的支持，可以帮助优先考虑他们的竞争需求和关系的连续性。他们还希望提供者能够倾听和承认他们的需求，理解这些需求是独特的和波动的，并有一个关心的态度。这些受访者描述了一个理想的护理过程，即以患者为中心和个性化，并支持他们独特的问题星座，转移优先事项和多维决策。由主要联系人管理的个人和持续护理协调可以满足其中的一些需求。实现这些目标将需要开发有效的方法来评估患者护理需求和灵活的护理管理支持系统，以响应患者在不同时间对不同级别支持的需求。
Background. Most recommended care for chronic diseases is based on the research of single conditions. There is limited information on 'best' processes of care for persons with multiple morbidities. Our objective was to explore processes of care desired by elderly patients who have multimorbidities that may present competing demands for patients and providers.Methods. Qualitative investigation using one-on-one interviews of 26 community-dwelling HMO members aged 65-84 (50% male) who had, at a minimum, the combined conditions of diabetes, depression and osteoarthritis. Participants were chosen from a stratified random sample to have a range of 4-16 chronic medical conditions.Results. Participants' desired processes of care included: the need for convenient access to providers (telephone, internet or in person), clear communication of individualized care plans, support from a single coordinator of care who could help prioritize their competing demands and continuity of relationships. They also desired providers who would listen to and acknowledge their needs, appreciate that these' needs were unique and fluctuating and have a caring attitude.Conclusions. These respondents describe an ideal process of care that is patient centered and individualized and that supports their unique constellations of problems, shifting priorities and multidimensional decision making. Individual and ongoing care coordination managed by a primary contact person may meet some of these needs. Achieving these goals will require developing efficient methods of assessing patient care needs and flexible care management support systems that can respond to patients' needs for different levels of support at different times.